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Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease
A. El-Hussuna, MLM. Karer, NN. Uldall Nielsen, A. Mujukian, PR. Fleshner, I. Iesalnieks, N. Horesh, U. Kopylov, H. Jacoby, HM. Al-Qaisi, F. Colombo, GM. Sampietro, MV. Marino, M. Ellebæk, C. Steenholdt, N. Sørensen, V. Celentano, N. Ladwa, J....
Jazyk angličtina Země Velká Británie
Typ dokumentu časopisecké články
NLK
Directory of Open Access Journals
od 2017
PubMed Central
od 2017
Europe PubMed Central
od 2017
Oxford Journals Open Access Collection
od 2017-02-01
ROAD: Directory of Open Access Scholarly Resources
od 2017
PubMed
34518869
DOI
10.1093/bjsopen/zrab075
Knihovny.cz E-zdroje
- MeSH
- břišní absces * diagnostické zobrazování etiologie chirurgie MeSH
- Crohnova nemoc * komplikace chirurgie MeSH
- dospělí MeSH
- drenáž MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři MeSH
- seznamy čekatelů MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. METHODS: A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes. RESULTS: The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). CONCLUSION: Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.
Colorectal Surgery Unit Hospital Universitario Son Espases Mallorca Spain
Department of Biomedical Sciences Humanitas University Milan Italy
Department of Clinical Medicin Aalborg University Aalborg Denmark
Department of Colorectal Surgery Vall d'Hebron University Hospital Barcelona Spain
Department of Gastroentrology Herlev University Hospital Herlev Denmark
Department of Medicine Universidad Francisco de Vitoria Madrid Spain
Department of Surgery Aalborg University Hospital Denmark
Department of Surgery Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello Palermo Italy
Department of Surgery Cedars Sinai Medical Center Los Angeles California USA
Department of Surgery Faculty of Medicine Gazi University Ankara Turkey
Department of Surgery Hospital del Mar Barcelona Spain
Department of Surgery Hvidovre Hospital Denmark
Department of Surgery Kocaeli University School of Medicine Turkey
Department of Surgery Portsmouth Hospitals NHS Trust Portsmouth UK
Department of Surgery St Mark's and Northwick Park Hospital UK
Department of Surgery Städtisches Klinikum München Bogenhausen Munich Germany
Department of Surgery Universidad Francisco de Vitoria Madrid Spain
Department of Surgery Università degli Studi di Milano Milan Italy
Department of Surgery University Hospital La Fe University of Valencia Spain
Division of General and HPB Surgery Luigi Sacco Hospital Milan Italy
Research Unit for Surgery and IBD Care Odense University Hospital Odense Denmark
Citace poskytuje Crossref.org
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- $a BACKGROUND: In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. METHODS: A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes. RESULTS: The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). CONCLUSION: Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.
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